a) The identified client has no desire or intent to cooperate.
b) Relationship boundaries are routinely violated.
c) There is a pattern of family secret-keeping.
d) Family members are deliberately destructive and deceitful.

3. A social worker is seeing a 29-year-old male in a court-ordered anger management program. He has a history of assaultive behavior that has resulted in his arrest multiple times in the past. Most recently, he was arrested for assaulting his live-in girlfriend with whom he shares a child. This arrest resulted in the counseling order. Over time, the girlfriend allowed a restraining order to lapse and has permitted him back in the home. During a session the client becomes agitated and angry when discussing the girlfriend and her “controlling ways.” Finally, he terminates the session by stalking out, saying that he will have to “deal with her” himself. No explicit threat was voiced, but his level of anger was high and his history is concerning. The MOST appropriate response is to:

a) Do nothing, as no explicit threat was made.
b) Call the girlfriend and disclose the potential for violence given his level of agitation when he left.
c) Carefully document the session and any relevant concerns to avoid possible subsequent liability.
d) Call law enforcement for a consultation.

4. The following criteria are all used to distinguish substance abuse from substance dependence EXCEPT:

a) Symptoms of substance abuse are usually less severe than those of dependence.
b) The problematic effects of abuse are usually limited to family, finances, employment, and legal issues (e.g., driving under the influence), while dependence also involves significant physiological problems.
c) Substance abuse typically involves narcotics, while dependence typically involves non-narcotic drugs.
d) Abuse is typically limited to recreational use, while dependence involves the need for increasing doses for the desired effect and withdrawal symptoms if not used regularly.

5. A social worker administers a “Draw-a-Person” test to a young child during an assessment interview. The test is designed to evaluate:

6. A 22-year-old female has been referred to a social worker for treatment of her fear of flying. She is getting married and hopes to honeymoon in Hawaii, and desperately wants to overcome her fear. She has no relevant history of trauma related to heights or flying. The social worker receiving the referral was trained in and exclusively uses a psychoanalytic approach to treatment. In this situation, for optimal treatment, the social worker should refer the client to someone specializing in:

7. As a social worker working with clients in a court-ordered treatment program, often the MOST difficult treatment issue is:

a) The social worker’s own personal feelings about the problem being treated.
b) Client anger at being coerced into the treatment process.
c) Client ambivalence about the need for treatment.
d) The limited availability of help for the client.

8. During an intake interview, a client addresses numerous issues and concerns. She has been coping with multiple personal health issues, a child is having problems in school, and her husband is increasingly abusing alcohol which is affecting their marriage. As she talks, her speech becomes rapid and intense, reflecting the stress she feels at each of these concerns. At this juncture, the social worker’s BEST response would be to:

a) Focus on the husband’s drinking and the problems this creates for the family.
b) Acknowledge her many challenges and ask which she wants to focus on.
c) Hear each of the client’s complaints, and then summarize and review them at the close of the session.
d) Encourage the client to specify more clearly why she came for help.

9. A 52-year-old man has been referred to see a social worker for “family and work problems.” Two months ago he lost his job as an executive in a major corporation, and has not found new work. On intake, the social worker discovered his drinking had increased and he reported feeling depressed most days. He stated that he couldn’t seem to enjoy doing anything, not even golf, which he used to love. Rather, all he could do was sleep and “sit around the house.” He felt useless, empty, and helpless to change his situation. He had tried reading the want ads, but he just couldn’t seem to focus. He had gained over 18 pounds. Then he added, “Sometimes I seem to hear voices, telling me I’m just ‘no good,’ and that things will never get better. When that happens, I try to plug my ears, but it doesn’t help. Only drinking seems to get the voices to stop. Do you think I’m going crazy?” The client’s probable primary diagnosis is:

10. After a therapeutic relationship has ended, a client approaches a social worker to join in various family activities (birthday celebrations, holiday events, etc). In light of the fact that a past professional relationship existed, yet acknowledging that it has formally ended, the social worker’s BEST response would be to:

a) Attend only small family gatherings as a show of care and support.
b) Accept any invitation that time will allow to show uncompromising support.
c) Attend some events, and invite the client out to others as well, so that the activities do not become one-sided.
d) Clarify that even after a professional relationship ends, socializing is not appropriate.

11. A social worker is seeing a woman who has been diagnosed with HIV (she is seropositive but is not yet symptomatic with symptoms of the AIDS syndrome). She has revealed that she is having unprotected sex with a new boyfriend. Further, she shares needles with him in mutual drug use situations. She also admits that he does not know she is HIV positive. The social worker has counseled her at length to reveal her status to the boyfriend, but she refuses. She indicates that if she tells him of her situation, he will leave her. Thus, she flatly refuses to disclose her condition to him. In this situation the MOST appropriate response would be to:

a) Inform the client that if she does not discontinue the behaviors or have the boyfriend acknowledge that he is aware of her condition within one month, the social worker will be required to warn him over her objections.
b) Call local law enforcement and ask them to evaluate the situation.
c) Continue counseling her, but do nothing more about the situation.
d) Make an immediate effort to contact the boyfriend and warn him.

12. A county mental health case management social worker is called about a potentially abusive situation in a residential care facility. A client with a diagnosis of paranoid schizophrenia and a history of amphetamine abuse has threatened a female developmentally-delayed co-resident. He stated that unless she would have sex with him, he would destroy a very expensive electronic keyboard that her parents had given her. When she refused, he removed the instrument from its case, pulled back the felt coverings, and poured water over the instrument. The facility wants to evict the client for his behavior. His parents are contending that no one was hurt and that the client shouldn’t be held accountable due to his mental health condition. They state they will pay for the damaged instrument. The BEST response by the social worker would be to:

a) Hold the client blameless, given the client’s condition and the lack of harm.
b) Seek short-term mental health hospitalization for the client to adjust his medications.
c) Agree to the eviction and seek an alternate placement for the client.
d) Point out that the co-resident had an “attractive nuisance” (the keyboard) in the facility that would unduly draw problems with other residents.

13. Prior to entering into therapy, a couple attempted to work out their differences by writing out individual summaries of their most pressing concerns. Upon entering counseling they submitted copies of these summaries to the social worker for review and feedback. Angry that the husband had pointed out some of her more egregious problems in writing, the wife rifled through the husband’s desk at home and tore up the original written summary he had written. Angry at the destruction of the painstakingly written summary, the husband requests a replacement copy from the social worker. The social worker’s MOST appropriate response would be to:

a) Provide the husband with a copy of his summary letter.
b) Deny the husband a copy of his summary letter.
c) Meet later to discuss his request with the couple together.
d) Ask the wife why she tore up the summary letter.

14. A hospital social worker is called to intervene because a physician is unable to secure informed consent from an elderly widowed female Asian patient for an upcoming surgery. In evaluating the patient, the social worker finds that the patient is awake, alert, and cognitively intact. However, the patient repeatedly insists that she “does not want to know anything” about her surgery, and tells the social worker that her eldest son will make all decisions for her. In responding to the referral, the social worker should:

a) Refer the patient for a more in depth psychiatric evaluation.
b) Refer the patient for a bioethics consult.
c) Explain to the physician that the patient has a right to remain uninformed.
d) Contact Adult Protective Services to investigate the son’s role in the patient’s care.

15. A social worker is approached by a couple in their mid-thirties. Both are successful in their careers and other relationships (friends and extended family), but they are having problems with their sexual relationship. He feels she pushes him away, and she feels emotionally distant from her husband. They mutually decided not to have children when they married. The FIRST issue the social worker must explore is:

a) Their sexual relationship.
b) Their decision not to have children.
c) Their career goals.
d) Their overall relationship.

16. Personality disorders are pervasive and enduring patterns of dysfunction. The DSM provides for the diagnosis of ten specific personality disorders, and one category for indeterminate behaviors that appear to be characteristic of a personality disorder. All are coded on Axis II of the multiaxial DSM diagnostic schema. These disorders are grouped into clusters. Identify the cluster that does not properly describe a personality disorder group:

17. A social worker is called to evaluate a 64-year-old male with chronic obstructive pulmonary disease. He lives in an assisted living facility, and was brought to a hospital Emergency Department by his daughter. She had taken him to lunch, and became distressed when he refused to return to the facility. He states he wants to live in his motor home, as he resents the loss of privacy at the facility. His daughter confirms he owns a working, fully self-contained motor home (i.e., stove, shower, refrigerator, etc). He has adequate funds. He plans to park the motor home in a nearby Kampgrounds of America (KOA) campground, where all utilities can be hooked up. He can have food and other supplies delivered. However, it is November and it is unseasonably cold. The doctor confirms that the patient is prone to pneumonia, and the daughter states, “He will die if he doesn’t return to the facility.” The patient refuses to consider any other living situation. In this situation, the social worker should:

a) Call the police and have them take the patient back to the facility.
b) Call Adult Protective Services for further intervention.
c) Allow the patient to move into his motor home.
d) Place the patient on an involuntary hold for suicidal behavior.

18. A woman seeks premarital counseling from a social worker. At the outset she notes that her fiance is of an ethnicity that is different from her own. Her family is not supportive of this, and she reports ambivalent feelings about proceeding with the marriage. The FIRST step the social worker should take is:

a) Schedule a couple’s session to examine how they can best cope after they are married.
b) Explore ways to help improve her family’s acceptance of her fiance.
c) Evaluate the impact that the issue of ethnicity currently has on the relationship.
d) Invite the client to attend an upcoming marriage preparation seminar.

19. A couple enters a counseling session with a social worker and soon begins bickering and yelling at each other. The outburst followed four sessions of careful therapeutic work aimed at helping the couple overcome this destructive communication pattern. The social worker now took a different tack and firmly stated, “Obviously you don’t want to change; you should fight like this as often as possible!” This technique is called:

20. A social worker in a counseling crisis center tells her supervisor that she is often feeling overwhelmed and frustrated with the endless complaints of clients. She also feels that her caseload is extremely heavy, leaving her with little energy to devote to each client. From what she has shared, the supervisor recognizes the classic symptoms of: